A report just published on UHC (Maeda et al 2014) is a synthesis of case studies from 11 countries experience of UHC.
“The goals of UHC are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out of pocket payments for health care or loss of income when a household member falls sick”. (p1).
The 11 countries are committed to the goals of UHC, and are willing to explore and share their experiences with others. While each country’s health system brings its own unique history and confronts its own set of challenges, each country’s experiences offer valuable insights into some of the common challenges and opportunities faced by other countries at all stages of UHC.
The Key Policy Messages in the document are:
• Strong national and local political leadership and long-term commitment are required to achieve and sustain UHC. Adaptive and resilient leadership is required, capable of mobilizing and sustaining broad-based social support while managing a continuous process of political compromises among diverse interest groups without losing sight of the UHC goals.
• Countries need to invest in a robust and resilient primary care system to improve access as well as manage health care costs.
• Investments in public health programs to prevent public health risks and promote healthy living conditions are essential for effective and sustainable coverage.
• Economic growth helps with coverage expansion, but is not a sufficient condition for ensuring equitable coverage. Countries need to enact policies that redistribute resources and reduce disparities in access to affordable, quality care.
• Countries need to take a balanced approach between efforts to generate revenues and manage expenditures, while expanding coverage.
The 11 Countries in the UHC Study
The Asset approach to health emphasises community ‘assets’ and seeks to mobilise those to support health and well being. The UHC approach is about health care services which is the other side of the coin and focuses on dealing with illness and disease. The social determinants of health emphasise the conditions in which people are born, grow, live, work and die. These conditions are characterised by imbalances of money, power and resources at national and global level.
The UCH project thus seeks to address the health impacts of social conditions and does so by explicitly acknowledging the need for a redistributive orientation to the use of resources. This brings it firmly into the political sphere where the business of decisions around provision of health services, or rather ‘illness services’, occurs through the action of more or less powerful stakeholders. Graham Scambler’s ‘Greedy Bastards Hypothesis‘ illustrates the power of certain vested interest.
The UCH approach also is explicitly based on growth models of economic development , which for many countries is entirely appropriate, but for high carbon developed nations may be less so due to their past contributions to carbon emissions and their current continuing high level carbon footprints.
Thus the UCH approach needs to be seen in this context, that it is just one approach to health and makes assumptions about political economy. The UCH may or may not directly challenge the powerful players and vested interests whose primary aim is capital accumulation and ‘accumulation by dispossession‘ which adversely affects the health of populations through stripping them of health assets.